Significance of Combined 12-Core and Ultrasound-Guided Prostate Biopsy: Can Ultrasound Stand Alone?

Magnetic Resonance Imaging of the prostate (MRIP) has gained prominence in the detection of prostate cancer, often used alongside transrectal ultrasound-guided prostate biopsy (TRUS Bx). This study aimed to evaluate whether a combined approach using Fusion biopsy could replace the traditional Standard 12-core biopsy in detecting clinically significant prostate cancer (csPCA), specifically Grade group 2 or greater. A retrospective analysis was conducted on patients who underwent a Combined biopsy at Virginia Urology from November 2022 to June 2023. Eligible patients, those with Prostate Imaging Reporting and Data System (PI-RADS) scores of 3 and above, had their MRIP assessed by one of six radiologists. The biopsies were performed using the UroNav system by ten surgeons, and pathology results were confirmed by two pathologists. The analysis focused on identifying csPCA, with data evaluated using chi-square and t-tests. Among the 474 patients identified, MRIP results indicated that 30.2% had PI-RADS 3, 43.3% had PI-RADS 4, and 20.6% had PI-RADS 5. The combined biopsy method detected csPCA in 58.3% of cases, significantly outperforming either the systematic (45.8%) or targeted (47.0%) biopsies alone. However, for patients with PI-RADS 5, there was no significant difference in detection between Combined and Fusion methods. Overall, while the Combined biopsy showed superior results, the Standard biopsy remains a critical component of the diagnostic process, particularly in identifying csPCA across PI-RADS levels, suggesting its continued use alongside Fusion techniques, especially in high-volume PI-RADS 5 cases.